Principlism and the Future of Bioethics

Because of the problems associated with competing normative ethical theories, some bioethicists attempt to subvert or resolve these problems by finding an alternative approach. One approach is to ground ethical decision making not on any one ethical theory, since consensus cannot be achieved, but on ethical principles. According to Donald Ainslie, “despite differences at the level of theory, they [bioethicists] could agree at the level of principles. The different theories converge on the same set of principles” (2004, p. 2100). In this chapter, principlism, as this approach came to be known, is examined beginning with its introduction into the biomedical literature in the mid to late 1970s, followed by its rapid appropriation by bioethicists.

Although principlism should resolve the quality-of-care crisis, especially with its emphasis on autonomy, it actually seems to have acerbated the crisis with a “sick autonomy” (Tauber, 2005). Criticisms of principlism are also examined, along with a defense proffered by its adherents. I finally explore the alternatives to principlism, including deductivism, common morality, casuistry, and narrative ethics. The chapter concludes with a brief discussion of the future of bioethics.